By Ashley Laderer
The vast majority of people with periods have experienced premenstrual syndrome (PMS) at some point in their life. Even people without periods are at least aware of PMS (and usually love to tease us period-havers about PMSing).
But what about PMS’s evil step sister, premenstrual dysphoric disorder (PMDD)?
While about 75 percent of women experience PMS at some point in their lives, PMDD affects only 3-8 percent of women. Many people haven’t even heard of this disorder, and those who have heard of it have trouble understanding the severity of it, likening it to run-of-the-mill PMS.
“I’m usually a pretty positive, rational, and contented person, but PMDD makes me feel intensely anxious and ill at ease,” says PMDD-sufferer Ellen, 33.
PMDD is a similar condition to PMS, but its symptoms are much more severe, including intense depression, anxiety and tension and often affects the person’s quality of life.
“I feel like jumping out of my skin. I tend to wake up in the middle of the night with anxious thoughts, and I’m unable to fall back asleep. I get annoyed by everything and everyone. Stupid things make me cry, and I tend to take things very personally. The hypersensitivity is one of the worst symptoms because it leads to me getting into arguments with partners and friends.”
I feel like jumping out of my skin. I tend to wake up in the middle of the night with anxious thoughts, and I’m unable to fall back asleep.
When she’s experiencing her PMDD symptoms, Ellen feels like she has a completely different brain for those days of the month. The phenomena she’s describing is very typical of PMDD.
Signs and symptoms of PMDD
PMDD might manifest slightly different from person to person, but some of the main mental signs and symptoms of PMDD include:
Feelings of sadness and hopeless
Heightened anxiety and irritability
Mood swings
Less interest in activities that usually bring you joy
Changes in sleep: Insomnia or sleeping too much
Lack of energy
Changes in appetite
Difficulty concentrating
Suicidal thoughts
Some of the main physical symptoms of PMDD are similar to those of PMS, including:
Bloating
Breast tenderness
Headaches
If you experience several or more of these symptoms, you should certainly head to a doctor. Keep a journal tracking your periods, behaviors, moods, and other symptoms — this will come in handy when it comes down to making an official diagnosis.
How is PMDD different from PMS?
PMDD is much less common — but much more severe — than PMS.
“PMDD, by definition, is debilitating,” states Carly Snyder, M.D., a reproductive and perinatal psychiatrist. “The symptoms – which occur during the second half, or luteal phase of one’s menstrual cycle – are intense and severely negatively impact daily life.”
These symptoms are often impossible to ignore and will get in the way of many aspects of life, from work (or school) to interpersonal relationships.
I feel like jumping out of my skin. I tend to wake up in the middle of the night with anxious thoughts, and I’m unable to fall back asleep.
Therapist Amanda Frey, LCSW, recommends, “Ask yourself: are my premenstrual symptoms feeling totally overwhelming? Am I missing work or school due to these symptoms? Do my emotions feel extremely intense and out of my control during this premenstrual period of time? Am I feeling intense anger or mood swings during this time that are affecting my relationships?”
She urges people who answer “yes” or “maybe” to these questions to reach out to their doctor.
Treatment options for PMDD
Luckily, there are a few different treatment options for PMDD that can alleviate its mental symptoms, which are often much more debilitating than the physical symptoms.
Here are some common treatment options for PMDD:
Therapy
Since many PMDD symptoms affect thought patterns and emotions, therapy is very useful for coping and learning new skills to deal with depression, anxiety, and suicidal ideation. There are a few different types of therapy, but Frey specifically recommends DBT (dialectical behavior therapy).
“Distress tolerance and emotion regulation that are taught as part of the DBT curriculum would be extremely helpful,” she says. “Learning DBT crisis techniques when you are in the midst of an extreme mood swing can be invaluable for the continued health of the relationships in your life.” Recent research has also found that DBT may be more effective than more traditional talk therapy.
Birth Control
Birth control can act as a first line of action when it comes to medical treatment. The pill prevents ovulation and can make for less severe periods and symptoms surrounding both PMS and PMDD. Christine Greves, M.D., OB-GYN says “With the [combined oral contraceptive pill] you can try to suppress what we call the HPO axis, or, hypothalamic-pituitary-ovarian axis, to just stop these cyclic changes.” This is the system that essentially controls the reproductive system.
“If a woman needs to have birth control anyway, and she has no contraindications to getting the combined oral contraceptive pill, it’s a great thing to try if they don't want to try SSRIs (antidepressants) right away,” Greves adds. She notes that drospirenone, a progestin ingredient in some birth control pills, is effective for PMDD. Yaz, for example, contains drospirenone, and is the only birth control that’s FDA approved for PMDD. “We don’t hand them out like candy since they have a higher risk of blood clots [than other birth control pills], but everything is risk versus benefits,” she says.
We don’t hand them out like candy since they have a higher risk of blood clots [than other birth control pills], but everything is risk versus benefits
Antidepressants
A class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed meds for PMDD. “Medications should be prescribed for women whose lives are negatively impacted and they are unable to function,” says Snyder. “It is a medical illness that benefits from proper treatment.”
A variety of SSRIs may be prescribed to people suffering from PMDD, and have been proven to reduce PMDD symptoms in clinical studies. “SSRIs such as Prozac, Zoloft, Celexa, and SNRIs like Effexor are very effective,” Snyder says. “Pattern of usage very much depends on the woman and her symptoms and preference. Women who solely have symptoms during the week or so prior to menses with symptom resolution upon onset of their period can opt to take antidepressants only when they are symptomatic, in a so-called luteal phase only.”
If someone experiences anxiety or depression symptoms other times of the month as well, an option is to take SSRIs daily throughout the month, and the dose can be increased during the luteal phase. Snyder notes that regardless of pattern of usage for SSRIs, some people report that a combination of SSRIs and birth control works best for them.
Self care for PMDD
Self care is crucial for people both with and without PMDD. Indulging in self care rituals that work for you can keep your mental and physical health in tip-top shape.
“Consider prioritizing self care to be non-negotiable. Understand what your emotional boundaries and limits are during times that your symptoms are most severe,” Frey says. “Most importantly, the not-so-fun part of self care is doing the work: going to the doctor's appointments and learning how to advocate for yourself.”
Consider prioritizing self care to be non-negotiable.
Some ideas for PMDD self care:
Take a long hot bath to soothe your physical pain and de-stress.
Exercise in any way you see fit, since exercise releases feel-good chemicals that can put you in a better mood and relieve pain.
Improve your diet, and don’t skip meals.
Interact with loved ones, whether you’re venting to them or just doing something fun and forgetting about your PMDD for a bit. Sometimes when you’re feeling depressed, it’s easy to want to isolate yourself, however, that really can make things worse.
Journaling is a great self care tool. You can do this in different ways, and find which method is your favorite. You can do a “brain dump” where you just dump all your thoughts onto paper, thereby externalizing them, or you can make gratitude lists each day of things you’re grateful for.
Never hesitate to ask for help. You are not in this alone! Especially if you are feeling suicidal, reach out to a loved one and/or a hotline like the National Suicide Prevention Lifeline.
If you suffer from PMDD or think you might, there’s hope for you. You don’t have to experience physical and mental pain every single month! It might take some time and trial and error to figure out what is the best treatment plan for you, but once you get diagnosed, get the proper help you need, and find the right meds, it’ll be worth it.
Want to read more?
Check out Figuring out PCOS on my own terms
Ashley Laderer is a contributor to the Public Goods Blog, a publication about health, sustainability and people making an impact. Check it out for a wide range of topics: everything from composting tips and essential oils to animal products and phosphates.
